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Office of Medicare Hearings and Appeals (OMHA)

Montage of beneficiariesOMHA administers appeal hearings for the Medicare program.  There are five levels in the Medicare claims appeal process.  OMHA's Administrative Law Judges hold hearings and issue decisions related to Medicare coverage determinations that reach Level 3 of the Medicare claims appeal process.  This Web site was created to help you learn more about Level 3 appeals.  Basic descriptions of the other levels are also provided, to assist you in understanding the appeal process.
 

If you wish to file a new appeal at Level 1, please visit Medicare.gov.  If you wish to learn more about Level 2 appeals, please see our summary of the Level 2 appeals process.   For Level 3 appeals, please choose among the following options:
 

  • If you were denied coverage for part or all of a medical service that you believe should have been covered by Medicare, see Coverage and Claims Appeals for guidance;

  • If you were told you are not eligible for Medicare, see Entitlement Appeals for guidance; or

  • If you think your Part B Premium rate should be lowered, see Part B Premium Appeals for guidance. 

 

OMHA Medicare Appellant Forum - October 29, 2014 

OMHA Statistical Sampling

OMHA Settlement Conference Facilitation

OMHA’s Request for Information-Federal Register Notice [PDF-260KB]

 

Tips for Filing a Request for ALJ Hearing

 Information on Adjudication Timeframes, Assignment of New Requests, and Escalation Rights

Information on CMS Ruling 1455-R 

(Part B Billing Options for Denied Part A Hospital Claims)